Published online Jan 27, 2021. doi: 10.4240/wjgs.v13.i1.30
Peer-review started: August 3, 2020
First decision: September 17, 2020
Revised: September 22, 2020
Accepted: December 2, 2020
Article in press: December 2, 2020
Published online: January 27, 2021
Processing time: 164 Days and 0.8 Hours
The management of cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for the pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease.
To compare the safety, efficacy, and short- and long-term results of PD and PPDR in patients with CDDW.
A retrospective analysis of the clinical, radiologic, pathologic, and intra- and postoperative data of 84 patients with CDDW (2004-2020) and a comparison of the safety and efficacy of PD and PPDR.
Symptoms included abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%) and data from computed tomography, magnetic resonance imaging, and endoUS led to the correct preoperative diagnosis in 98.8% of cases. Twelve patients were treated conservatively with pancreaticoenterostomy (n = 8), duodenum-preserving pancreatic head resection (n = 6), PD (n = 44) and PPDR (n = 15) without mortality. Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR (93%) and PD (84%) compared to the other treatment modalities (18%). New onset diabetes mellitus and severe exocrine insufficiency occurred after PD (31% and 14%), but not after PPDR.
PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW. The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease. Early detection of CDDW provides an opportunity for pancreas-preserving surgery.
Core Tip: This is a retrospective study that compared the safety, efficacy, short- and long-term results of pancreatoduodenectomy (PD) and pancreas-preserving duodenal resections (PPDR) in patients with groove pancreatitis (GP). Although PD is a conventional option for GP management, PPDR has been suggested as a treatment alternative for the pure form of GP in the early stage of this disease. Evaluation of these two treatment modalities has shown that PPDR for the pure form of GP is similar in terms of safety and better in efficacy compared to PD performed for GP. The key aim of this study is to demonstrate that PPDR may be the treatment of choice for the pure form of GP, which is a disease of the duodenum; early detection of GP makes preservation of the pancreas possible, and prolonged conservative treatment in early GP may lead to the development of segmental and diffuse pancreatitis, which may deprive patients of the pancreas-preserving option; PD is an overtreatment for the pure form of GP, since it involves resection of undamaged pancreas, which means that PPDR may be an alternative treatment procedure for GP.